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H 7347Health Insurance

Insurance - Accident and Sickness Insurance Policies

This bill restricts insurance companies from requiring permission before patients receive initial physical therapy or chronic pain treatments.

Held for study
Population
Affected
35
Email Legislator
Introduced Jan 28, 2026Committee House Health & Human Services

Plain-English Summary

This legislation limits when health insurance companies can require "prior authorization" (permission before treatment) for physical therapy and rehabilitation services. Insurers cannot demand prior authorization for the first 12 visits of a new condition or the first 90 days of chronic pain treatment. It sets strict deadlines, requiring insurers to approve or deny requests within 24 hours. If they miss the deadline, the request is automatically approved. Additionally, it allows patients to get approval retroactively if the treatment was medically necessary but permission wasn't obtained beforehand.

For younger readers

Sometimes when people get hurt, they need special exercises called physical therapy to get better. Usually, insurance companies make doctors ask for permission before they can help the patient, which takes a long time. This new rule says insurance companies cannot make doctors ask for permission for the first few visits. It also says that if the insurance company takes too long to answer a request for more visits, the answer is automatically "yes." This helps people get their treatment faster without waiting for paperwork.

Who & Where It Applies

Impacted groups
Patients with chronic painPhysical therapistsHealth insurance companiesIndividuals needing rehabilitationHealthcare providers
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Increases access to essential healthcare by removing bureaucratic hurdles that often delay rehabilitative treatment for patients recovering from injuries or managing chronic conditions.
  • Promotes non-pharmacologic pain management strategies, such as physical therapy, which can help reduce reliance on opioids and combat the addiction crisis in the community.
  • Holds insurance corporations accountable by mandating rapid response times for authorization requests, ensuring that administrative delays do not compromise patient health and well-being.
  • Allows insurance companies to perform retrospective medical necessity reviews, meaning patients or providers could still face financial liability for services after they have been delivered.
  • Could lead to increased insurance premiums if insurers pass the administrative or treatment costs on to consumers, disproportionately affecting low-income individuals.
  • Does not fundamentally alter the for-profit insurance model or move the state closer to a single-payer system, serving only as a patch on an existing inequitable system.
For Conservatives
  • Reduces bureaucratic red tape by eliminating the need for constant permission slips from insurance companies for standard medical treatments.
  • Empowers individuals and their doctors to make immediate healthcare decisions regarding physical therapy without government-regulated corporate interference.
  • Encourages personal responsibility and recovery by facilitating immediate access to physical rehabilitation and non-drug pain management rather than reliance on pharmaceuticals.
  • Imposes heavy government regulations on private insurance businesses, dictating their internal operational procedures and response times.
  • Likely to result in higher insurance premiums for all policyholders as companies adjust to the inability to manage costs through prior authorization mechanisms.
  • Interferes with the free market and private contracts by mandating specific coverage terms and approval processes, rather than letting the market determine efficient healthcare delivery.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 176 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Prior authorization restrictions for rehabilitative and habilitative services.

(a) An individual or group health insurance plan shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services for the first twelve (12) visits of each new episode of care. After the twelve (12) visits of each new episode of care, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this section, "new episode of care" means treatment for a new or recurring condition for which an insured has not been treated by the provider within the previous ninety (90) days.

(b) An individual or group health insurance plan shall not require prior authorization for physical medicine or rehabilitation services provided to patients with chronic pain for the first ninety (90) days following diagnosis in order to provide the necessary nonpharmacologic management of the pain. After the first ninety (90) days following a chronic pain diagnosis, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this subsection, "chronic pain" means pain that persists or recurs for more than three (3) months.

(c) An individual or group health insurance plan shall respond to a prior authorization request for services or visits in an ongoing plan of care for rehabilitative or habilitative services within twenty-four (24) hours. If an individual or group health insurance plan requires more information to render a decision on the prior authorization request, the individual or group health insurance plan shall notify the patient and the provider within twenty-four (24) hours of the initial request with the information that is needed to complete the prior authorization request including, but not limited to, the specific tests and measures needed from the patient and provider. An individual or group health insurance plan shall render a decision on the prior authorization request within twenty-four (24) hours of receiving the requested information.

(d) A prior authorization for rehabilitative or habilitative services is deemed to be approved if an individual or group health insurance plan:

(1) Fails to timely answer a prior authorization request in accordance with subsection (c) of this section, including due to a failure of the individual or group health insurance plan’s prior authorization platform or process; or

(2) Informs a provider that prior authorization is not required orally, via an online platform or program, through the patient's health plan documents or by any other means.

(e) An individual or group health insurance plan shall provide a procedure for providers and insureds to obtain retroactive authorization for rehabilitative or habilitative services that are medically necessary covered benefits. An individual or group health insurance plan shall not deny coverage for medically necessary services for failure to obtain a prior authorization, if a medical necessity determination can be made after the rehabilitative or habilitative services have been provided and the services would have been covered benefits if prior authorization had been obtained.

(f) An individual or group health insurance plan’s failure to approve a prior authorization for all rehabilitative or habilitative services or visits in a plan of care is subject to the same appeal rights as a denial under the health insurance commissioner’s rule regarding health plan accountability and the provider's network agreement with the carrier, if any.

(g) Nothing in this section shall be construed to prohibit an individual or group health insurance plan from performing a retrospective medical necessity review.

SECTION 2. Chapter 27-19 of the General Laws entitled " Nonprofit Hospital Service Corporations " is hereby amended by adding thereto the following section: 27-19-88. Prior authorization restrictions for rehabilitative and habilitative services.

(a) An individual or group health insurance plan shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services for the first twelve (12) visits of each new episode of care. After the twelve (12) visits of each new episode of care, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this section, "new episode of care" means treatment for a new or recurring condition for which an insured has not been treated by the provider within the previous ninety (90) days.

(b) An individual or group health insurance plan shall not require prior authorization for physical medicine or rehabilitation services provided to patients with chronic pain for the first ninety (90) days following diagnosis in order to provide the necessary nonpharmacologic management of the pain. After the first ninety (90) days following a chronic pain diagnosis, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this subsection, "chronic pain" means pain that persists or recurs for more than three (3) months.

(c) An individual or group health insurance plan shall respond to a prior authorization request for services or visits in an ongoing plan of care for rehabilitative or habilitative services within twenty-four (24) hours. If an individual or group health insurance plan requires more information to render a decision on the prior authorization request, the individual or group health insurance plan shall notify the patient and the provider within twenty-four (24) hours of the initial request with the information that is needed to complete the prior authorization request including, but not limited to, the specific tests and measures needed from the patient and provider. An individual or group health insurance plan shall render a decision on the prior authorization request within twenty-four (24) hours of receiving the requested information.

(d) A prior authorization for rehabilitative or habilitative services is deemed to be approved if an individual or group health insurance plan:

(1) Fails to timely answer a prior authorization request in accordance with subsection (c) of this section, including due to a failure of the individual or group health insurance plan’s prior authorization platform or process; or

(2) Informs a provider that prior authorization is not required orally, via an online platform or program, through the patient's health plan documents or by any other means.

(e) An individual or group health insurance plan shall provide a procedure for providers and insureds to obtain retroactive authorization for rehabilitative or habilitative services that are medically necessary covered benefits. An individual or group health insurance plan shall not deny coverage for medically necessary services for failure to obtain a prior authorization, if a medical necessity determination can be made after the rehabilitative or habilitative services have been provided and the services would have been covered benefits if prior authorization had been obtained.

(f) An individual or group health insurance plan’s failure to approve a prior authorization for all rehabilitative or habilitative services or visits in a plan of care is subject to the same appeal rights as a denial under the health insurance commissioner’s rule regarding health plan accountability and the provider's network agreement with the carrier, if any.

(g) Nothing in this section shall be construed to prohibit an individual or group health insurance plan from performing a retrospective medical necessity review.

SECTION 3. Chapter 27-20 of the General Laws entitled " Nonprofit Medical Service Corporations " is hereby amended by adding thereto the following section: 27-20-84. Prior authorization restrictions for rehabilitative and habilitative services.

(a) An individual or group health insurance plan shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services for the first twelve (12) visits of each new episode of care. After the twelve (12) visits of each new episode of care, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this section, "new episode of care" means treatment for a new or recurring condition for which an insured has not been treated by the provider within the previous ninety (90) days.

(b) An individual or group health insurance plan shall not require prior authorization for physical medicine or rehabilitation services provided to patients with chronic pain for the first ninety (90) days following diagnosis in order to provide the necessary nonpharmacologic management of the pain. After the first ninety (90) days following a chronic pain diagnosis, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this subsection, "chronic pain" means pain that persists or recurs for more than three (3) months.

(c) An individual or group health insurance plan shall respond to a prior authorization request for services or visits in an ongoing plan of care for rehabilitative or habilitative services within twenty-four (24) hours. If an individual or group health insurance plan requires more information to render a decision on the prior authorization request, the individual or group health insurance plan shall notify the patient and the provider within twenty-four (24) hours of the initial request with the information that is needed to complete the prior authorization request including, but not limited to, the specific tests and measures needed from the patient and provider. An individual or group health insurance plan shall render a decision on the prior authorization request within twenty-four (24) hours of receiving the requested information.

(d) A prior authorization for rehabilitative or habilitative services is deemed to be approved if an individual or group health insurance plan:

(1) Fails to timely answer a prior authorization request in accordance with subsection (c) of this section, including due to a failure of the individual or group health insurance plan’s prior authorization platform or process; or

(2) Informs a provider that prior authorization is not required orally, via an online platform or program, through the patient's health plan documents or by any other means.

(e) An individual or group health insurance plan shall provide a procedure for providers and insureds to obtain retroactive authorization for rehabilitative or habilitative services that are medically necessary covered benefits. An individual or group health insurance plan shall not deny coverage for medically necessary services for failure to obtain a prior authorization, if a medical necessity determination can be made after the rehabilitative or habilitative services have been provided and the services would have been covered benefits if prior authorization had been obtained.

(f) An individual or group health insurance plan’s failure to approve a prior authorization for all rehabilitative or habilitative services or visits in a plan of care is subject to the same appeal rights as a denial under the health insurance commissioner’s rule regarding health plan accountability and the provider's network agreement with the carrier, if any.

(g) Nothing in this section shall be construed to prohibit an individual or group health insurance plan from performing a retrospective medical necessity review.

SECTION 4. Chapter 27-41 of the General Laws entitled " Health Maintenance Organizations " is hereby amended by adding thereto the following section: 27-41-101. Prior authorization restrictions for rehabilitative and habilitative services.

(a) An individual or group health insurance plan shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services for the first twelve (12) visits of each new episode of care. After the twelve (12) visits of each new episode of care, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this section, "new episode of care" means treatment for a new or recurring condition for which an insured has not been treated by the provider within the previous ninety (90) days.

(b) An individual or group health insurance plan shall not require prior authorization for physical medicine or rehabilitation services provided to patients with chronic pain for the first ninety (90) days following diagnosis in order to provide the necessary nonpharmacologic management of the pain. After the first ninety (90) days following a chronic pain diagnosis, an individual or group health insurance plan may not require prior authorization more frequently than every six (6) visits or every thirty (30) days, whichever time period is longer. For purposes of this subsection, "chronic pain" means pain that persists or recurs for more than three (3) months.

(c) An individual or group health insurance plan shall respond to a prior authorization request for services or visits in an ongoing plan of care for rehabilitative or habilitative services within twenty-four (24) hours. If an individual or group health insurance plan requires more information to render a decision on the prior authorization request, the individual or group health insurance plan shall notify the patient and the provider within twenty-four (24) hours of the initial request with the information that is needed to complete the prior authorization request including, but not limited to, the specific tests and measures needed from the patient and provider. An individual or group health insurance plan shall render a decision on the prior authorization request within twenty-four (24) hours of receiving the requested information.

(d) A prior authorization for rehabilitative or habilitative services is deemed to be approved if an individual or group health insurance plan:

(1) Fails to timely answer a prior authorization request in accordance with subsection (c) of this section, including due to a failure of the individual or group health insurance plan’s prior authorization platform or process; or

(2) Informs a provider that prior authorization is not required orally, via an online platform or program, through the patient's health plan documents or by any other means.

(e) An individual or group health insurance plan shall provide a procedure for providers and insureds to obtain retroactive authorization for rehabilitative or habilitative services that are medically necessary covered benefits. An individual or group health insurance plan shall not deny coverage for medically necessary services for failure to obtain a prior authorization, if a medical necessity determination can be made after the rehabilitative or habilitative services have been provided and the services would have been covered benefits if prior authorization had been obtained.

(f) An individual or group health insurance plan’s failure to approve a prior authorization for all rehabilitative or habilitative services or visits in a plan of care is subject to the same appeal rights as a denial under the health insurance commissioner’s rule regarding health plan accountability and the provider's network agreement with the carrier, if any.

(g) Nothing in this section shall be construed to prohibit an individual or group health insurance plan from performing a retrospective medical necessity review.

SECTION 2. This act shall take effect on January 1, 2027.